Background. Group B streptococci (GBS) are opportunistic bacteria capable of causing severe infections in pregnant women and newborn infants. For effective prevention of obstetrical and perinatal GBS-associated pathology, investigation into epidemiology of GBS carriage and GBS-associated diseases, as well as elaboration of accurate and rapid methods for GBS detection are necessary. Objectives. Validation of a molecular test for the detection of GBS and evaluation of frequency and risk factors of colonization of pregnant women with this microorganism. Methods. For validation of PCR test for the detection of GBS DNA (AmpliSens Streptococcus agalactiae-screen-titer-FL, Central Research Institute of Epidemiology, Moscow), 1496 clinical samples from 650 women and 112 newborn infants submitted for routine GBS culture were used. For evaluation of frequency and risk factors of GBS-colonization during pregnancy, clinical samples (urine, vaginal and rectal swab samples) from 496 women at their first prenatal visit before 12 weeks of gestation were used. GBS testing was performed using culture and the validated PCR test. For evaluation of risk factors, binomial logistic regression was used. Results. PCR method for GBS DNA detection showed high analytical sensitivity (3 ∙ 102 copies/ml) and specificity (no cross-reactions with other microorganisms). Diagnostic sensitivity and specificity of the test (81 and 97.6%, respectively) were comparable with those of culture (77.6 and 100%, respectively). GBS was detected in 16.3% of pregnant women. Testing of rectal samples in addition to vaginal samples enabled to detect 66.7% more cases of GBS carriage. Women aged 18 to 22 years had a higher risk of GBS colonization during pregnancy than older women (23 to 32 years). At the same time, women who had their sexual debut at an older age (after 18) were significantly more often colonized during pregnancy than women started their sex life at a younger age (before 18). Conclusion. PCR method for GBS detection has high sensitivity and specificity and can be used as an alternative to culture. Simultaneous testing of vaginal and rectal samples increases the sensitivity of revealing colonized women by two thirds in comparison with testing vaginal samples only. Younger age and later sexual debut are independent risk factors for GBS colonization during pregnancy.
The study investigates colonization of the genitourinary tract and rectum in pregnant women by Streptococcus agalactiae in early pregnancy, as well as pregnancy outcomes for mother and infant depending on the use of antibiotic prophylaxis. The frequency of GBS colonization was 15.9 %, with the detection rate in urine being 8.6 %, in the vagina - 3.5 %, in the rectum - 10 %. The efficiency of amoxicillin/clavulanic acid administered in the II trimester was 66.7 %. Pregnancy outcomes in women receiving and those not receiving antibiotic prophylaxis were studied. In all women receiving amoxicillin/clavulanic acid term labor occurred, with healthy full-term infants born. In one woman not receiving antibiotic prophylaxis there was preterm labor at 34 weeks of gestation.
Background. Bacteriuria caused by group B streptococci (GBS) is a major risk factor for neonatal GBS associated pathology and a risk factor for pregnancy complications such as preterm birth and preterm rupture of membranes. Objective. Clinical and microbiological rationale for the prophylaxis of obstetrical and perinatal pathology associated with group B streptococci. Methods. A total of 496 pregnant women who made their first prenatal visit within first 12 weeks of gestation were invited to participate. As clinical samples, mid-stream urine, vaginal swabs, rectal swabs from women and inguinal swabs, urine, meconium from newborn infants were used. GBS detection was performed using culture and PCR. Results. The frequency of GBS detection was 16.3%. GBS associated bacteriuria was detected in 9.8% of the women. The women having GBS in urine at the beginning of pregnancy were significantly more often colonized with the microorganism late in pregnancy in comparison with the women with GBS-colonization of the vagina and/or rectum. Microbiological efficiency of antibiotic therapy of GBS associated bacteriuria using amoxicillin/clavulanic acid exceeded 70%. Clinical efficiency of the therapy consisted in the reduction of preterm birth and preterm rupture of membranes by 25% and 40%, respectively. Conclusions. Antibiotic therapy of GBS associated bacteriuria results in a decrease of pregnancy complication, which necessitate its use. GBS-colonization of the vagina and rectum in pregnant women is transitory therefore antenatal screening for GBS aimed to prevent neonatal GBS-infection should be performed late in pregnancy or before delivery.
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